Damaris Munoz
Jacksonville
Summary
Dedicated nursing student actively pursuing an ADN in Nursing, with a strong grasp of the vital role nurses play in interdisciplinary settings. Possessing excellent clinical expertise and exceptional interpersonal abilities, well-equipped to provide compassionate and effective care to patients. Committed to continuous learning and professional growth, eager to contribute skills and knowledge to a dynamic healthcare team.
Overview
16
16
years of professional experience
Work History
Clinical Support Coordinator
New Directions Behavioral Health
05.2018 - Current
- Responsible for providing day to day administrative support for Utilization Management and Case Management programs and supports to members in transition from inpatient or residential services to community services
- Will assist member by addressing barriers to adhering to after care plans, assisting with problem resolution and coordinating with all departments within New Directions, facilities and providers to promote effective, efficient care for NDBH members
- Take initial calls from Members and Providers, answer administrative questions, and facilitate connections to the appropriate department or staff
- Review routine outpatient authorizations requests, Outpatient Quality Review (OQR) forms within desktop guidelines, with data entry into appropriate systems
- Coordinate with Network Operations staff to facilitate access to providers in the Member’s area
- Conduct post-hospitalization follow-up calls and assist with care coordination and access to community resources including scheduling 7-day aftercare appointments and assisting with addressing barriers to adhering to aftercare plans, e.g
- Transportation, prescriptions, etc
- Promotes quality service delivery and effective care transitions for optimal member health outcomes
- Provide information to members and providers regarding mental health and substance abuse benefits, community resources, mental health managed care programs, and New Directions’ services, policies and procedures
- Conduct outreach calls to members for engagement in program services
- Facilitate Utilization and/or Case Managers involvement as needed for high-risk follow-up or if member is unable to keep an appointment within 30 days of discharge
- Provides administrative support services to clinical staff and in meetings and committees as needed
- Complies with all Federal and applicable State laws and New Directions Behavioral Health Policies regarding, privacy, confidentiality, and security of health information, and other designated information
Eligibility Specialist (Bilingual)
NThrive
06.2017 - 05.2018
- Handles a high volume of inbound calls from patients that need to be screened financially and medically for healthcare financial support
- Using the company eligibility tool, determines patient eligibility for financial support
- Conducts the appropriate application support that should be provided based upon state regulations
- Facilitates the application process or directs the patient to the appropriate next step
- Acts as an advocate for the patient, but also serves as a liaison to other colleagues, client hospital personnel, and government agency staff in a collaborative effort to facilitate eligibility coverage for incurred medical expenses
- Provides superior customer service and maintains a professional image
- Demonstrated experience communicating effectively with a customer and simplifying complex information
- Experience in a role that requires accessing multiple databases simultaneously or managing multiple open screens to gather information to discuss with a customer
- Experience with customer interactions that require live, accurate documentation of the encounter
- Ability to handle sensitive information and maintain HIPAA compliance
- Demonstrated ability to navigate Internet Explorer and Microsoft Office
Bilingual Claims/Customer Service Advocate
Blue Cross Blue Shield of SC
02.2013 - 10.2016
- Answered inbound calls professionally
- Researched, calmed and rapidly resolved client conflicts to prevent loss of key accounts
- Resolved customer complaints
- Reviewed Claims for completeness, accuracy and correct coding
- Assisted members with questions regarding membership
- Communicated daily with customer, communicated information clearly and accurately
- Accustomed to fast paced, high pressured positions
- Demonstrated ability to prioritize multiple tasks, meet deadlines, and provide quality service
- Adjudicated medical claims per health plan polices
- Maintained strictest confidentiality; adhered to all HIPAA guidelines/regulations
- Met quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines
- Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, and, provider networks, etc
Bilingual Customer Service Representative
Kelly Service- Blue Cross Blue Shield of SC
03.2012 - 05.2012
- Answered inbound calls professionally
- Respond to customer inquiries
- Handle and resolved customer complaints
- Assisted members with questions regarding membership
- Kept record of customer inquiries
- Communicated daily with customer, communicated information clearly and accurately
- Researched, calmed and rapidly resolved client conflicts to prevent loss of key accounts
- Maintained strictest confidentiality; adhered to all HIPAA guidelines/regulations
Billing Department Representative
Inmed Diagnostics
02.2011 - 05.2011
- Answered questions from patients, clerical staff and insurance companies’
- Identified and resolved patient billing complaints
- Prepared, reviewed and sent patient statements
- Evaluated patient’s financial status and established budget payment plans
- Followed and reported status of delinquent accounts
- Reviewed accounts for possible assignment and made recommendations to the Billing Supervisor, also prepared information for the collection agency
- Performed various collection actions including contacting patients by phone, correcting and resubmitting claims to third party payers
- Processed payments from insurance companies
Dental Assistant
Baystate Dental (General Dentistry)
01.2009 - 04.2009
- Prepared patient for dental treatment by welcoming, comforting, seating, and draping patient
- Provided instrumentation by sterilizing and delivering instruments to treatment area; positioning instruments for dentist's access; suctioning; passing instruments
- Provided materials by selecting, mixing, and placing materials on instruments and in the patient's mouth
- Provided diagnostic information by exposing and developing radiographic studies; pouring, trimming, and polishing study casts
- Maintained patient appearance and ability to masticate by fabricating temporary restorations; cleaning and polishing removable appliances
- Educated patients by giving oral hygiene, plaque control, and postoperative instructions
- Documented dental care services by charting in patient records
- Maintained patient confidence and protected operations by keeping information confidential
- Maintained safe and clean working environment by complying with procedures, rules, and regulations
- Protected patients and employees by adhering to infection-control policies and protocols
- Maintained dental supplies inventory by checking stock to determine inventory level; anticipating needed supplies; placing and expediting orders for supplies; verifying receipt of supplies
Dental Assistant
Aspen Dental (General Dentistry)
10.2008 - 01.2009
- Prepared treatment room for patient by following prescribed procedures and protocols
- Prepared patient for dental treatment by welcoming, comforting, seating, and draping patient
- Provided information to patients and employees by answering questions and requests
- Provided instrumentation by sterilizing and delivering instruments to treatment area; positioning instruments for dentist's access; suctioning; passing instruments
- Provided materials by selecting, mixing, and placing materials on instruments and in the patient's mouth
- Provided diagnostic information by exposing and developing radiographic studies; pouring, trimming, and polishing study casts
- Maintained patient appearance and ability to masticate by fabricating temporary restorations; cleaning and polishing removable appliances
- Educated patients by giving oral hygiene, plaque control, and postoperative instructions
- Documented dental care services by charting in patient records
- Maintained patient confidence and protected operations by keeping information confidential
- Maintained safe and clean working environment by complying with procedures, rules, and regulations
- Protected patients and employees by adhering to infection-control policies and protocols
Education
Associate of Science - Nursing
Florida State College
Jacksonville, FL05-2025
Diploma - Dental Assistant
Porter And Chester Institute
Chicopee, MA10-2008
Diploma - Medical Assistant
Porter And Chester
Chicopee, MA03-1996
Skills
- HIPAA compliance
- Clinical documentation
- Clinical assessment
- Healthcare administration
Languages
Spanish
Full Professional
Timeline
Clinical Support Coordinator
New Directions Behavioral Health
05.2018 - Current
Eligibility Specialist (Bilingual)
NThrive
06.2017 - 05.2018
Bilingual Claims/Customer Service Advocate
Blue Cross Blue Shield of SC
02.2013 - 10.2016
Bilingual Customer Service Representative
Kelly Service- Blue Cross Blue Shield of SC
03.2012 - 05.2012
Billing Department Representative
Inmed Diagnostics
02.2011 - 05.2011
Dental Assistant
Baystate Dental (General Dentistry)
01.2009 - 04.2009
Dental Assistant
Aspen Dental (General Dentistry)
10.2008 - 01.2009
Associate of Science - Nursing
Florida State College
Diploma - Dental Assistant
Porter And Chester Institute
Diploma - Medical Assistant
Porter And Chester
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